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MSK Initiative
2nd Webinar
Low Back Pain
January 9, 2012
Agenda
 Webinar Housekeeping
 Project Update
 Tools Discussion
 Patient Self Management
 Evaluation Forms
 Feedback and Discussion
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Webinar Housekeeping

Audio and Visual
Sound
Chat Function

Save


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Attendees
Doctors:
Herb, Jane, Mona, Helene, David
Facilitators:
Julia, Bruce, Brenda, Liza, Pam, Laura
Impact BC Host:
Christina, Lisa
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Project Update Discussion
Tool Kit
– Explore the Tool Kit (Algorithm)
– Test all tools as they fit your patient/practice
– Provide Feedback on all tools
– Send feedback form to PSP Central Weekly
– Discuss project with coach support
www.gpscbc.ca/psp_msk
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Inventory of MSK TOOLS & their classification
 Clinical Practice Tools – used at point of care and tools we want tested
during trial period
 Reference Tools – checklists and other materials that can be looked up in
hard copy binder or in electronic format as physician interest and time permit
 Patient Tools – to be completed by patient either jointly with GP, in the
waiting room, or at home. These tools should be tested via GP pilot or with
patient focus groups
 Teaching Tools – optional for use in the learning / teaching sessions as aids
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Tuesday December 6, 2011
• Patient Questionnaire
Patient History
• Red Flags
• Yellow Flags
• Assessment of Pain and
Function
Monday January 9, 2011
• DN4
Monitoring and Management
• Opioid Manager
• RACE
• Green Light
• Patient Self-Management
Tools
• Personal Action Plan
• Low Back Patient
Handout
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Discussion Questions
1. Tell us how you implemented the tools into your
practice ?

Patient Tools ?
Clinical Tools ?
Reference Tools?

Teaching Tools ?


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Tools
Diagnostic Screening:
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DN4
Clinical Management:


Opioid Manager
RACE
Green Light
Patient Self-Management:

Personal Action Plan


LBP Handout
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Low Back Pain
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DN4 Questionnaire
Utility:
To estimate the probability of Neuropathic Pain
Method: 4 Questions
Score: Yes=1, No= 0
/10 Points
If the patients score is equal to or greater than 4, the test is
positive. (sensitivity: 82.9%; specificity: 89.9%)
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Opioid Manager
Assessment

Patient Goals

Opioid Risk
Management Trial
Dosage Chart

Overdose Risk
Initiation Checklist
Maintenance and
Monitoring Chart
When and How to Stop

Selection Approach
Drug related Behaviour

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RAPID ACCESS TO CONSULTATIVE EXPERTISE
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Timely Telephone Advice
Within 2 hours
Assistance with care plan
Continued Family Practice Management
Monday-Friday 8-5pm
604-696-2131 or 1-877-696-2131
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Giving Patients Green Light Advice
1. Stay Active -Usual Activities
2. Reassurance and Explanation
3. Pain Control
4. Return to Work
5. Ongoing management
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Follow-Up Visits:

Pain





Worst
Least
Average
Right Now
Function
•
•
•
•
Appreciate variation of pain intensity
Social/Physical/ Mood/ Work
Delve into various functional examples
Opportunity for educational intervention
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Patient Self Management
“The tasks that an individual must undertake to live
well with one or more chronic conditions. These
tasks include gaining confidence to deal with
medical management, role management, and
emotional management"
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Patient Self- Management Support
“ The systematic provision of education
and supportive interventions by health care staff to
increase patients’ skills and confidence in managing
their health problems, including regular assessment
of progress and problems, goal setting, and
problem-solving support.”
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Stepped Care for Self-management Support
Healthy
Communities and
Supportive Family, Friends, and
Caregivers
Offer Expert
Methods
Provide Advanced Approaches
(MI, Case Mgmt, PST, Group Interactions, etc.)
Use Self-management Support Core Techniques:
Goal Setting, Action Planning,
Problem solving, Follow-up
Honor
culture
Develop shared
understanding
Promote active
self-management
Based on the work of the Indian Health Service Improving Patient Care Self-management Support Workgroup and Division of Diabetes Treatment Program with input from the British
Columbia Ministry of Health Services Patients as Partners Committee and ImpactBC, 2011.
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Brief Action Planning (B.A.P.)
“Is there anything you would like to do for your health
In the next week or two?”
SMART Behavioral Contracting
Elicitation of Commitment Statement
“How confident (on a scale from 0 to 10) do you
feel about carrying out your plan?”
If Confidence >7
“When would you like to check in with me to
review how you are doing with your plan?”
Steven Cole, et. al.
Brief Action Planning (B.A.P.)
Behavioral
Menu
“Is there anything you would like to do for your health
In the next week or two?”
SMART Behavioral Contracting
Elicitation of Commitment Statement
“How confident (on a scale from 0 to 10) do you
feel about carrying out your plan?”
If Confidence <7, problem solve barriers
“When would you like to check in with me to
review how you are doing with your plan?”
Steven Cole, et. al.
Personal Action Plan
1.What is about your current health that worries you ?
2. How do you feel about this ?
3. What can you personally do about this issue ?
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National Resources: NGOs
Exercising with Arthritis
Managing pain
Eating healthy
Preventing fatigue
Protecting joints
Arthritis medications and working with your healthcare team
Dealing with stress and depression
Problem-solving
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Feedback Forms
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Complete for each patient interaction, multiple tools
per patient
Fax in every Friday
Easy Evaluation Tick Sheet
Open Boxes to add tools that are in the Tool kit but
not selected for testing
Composite trends to be fed forward to support
group
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Feedback Form
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Summary
1.
Connect with your Support Physician
2.
We need more data !
3.
Keep the comments coming.
4.
Your participation is appreciated.
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Next Webinar Date for Low Back Pain
Tuesday, March 6: 5 – 6:00 pm
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